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Health Sector

WHISTLEBLOWING IN THE HEALTH SECTOR

For those working in the health sector, work comes with significant responsibilities. This can become difficult if things start to go wrong. Raising your concerns about things happening at work can be an intimidating process, and it can be difficult to know who to speak to.

This webpage is designed for those working in the health sector, to help you understand what kind of concerns you can raise, what support you can get, what your legal protections are, and where you can go to raise your concerns.

It focuses on whistleblowing procedures in the NHS in England, Scotland and Wales, and Health and Social Care in Northern Ireland, but some of the advice will also apply to those in private healthcare.

Why should I raise my concerns?

At work, you may see something that you are concerned about or that you want to speak up about. Staff are often in a unique position to spot issues, including ones which could seriously impact on patient health and safety.

You don’t have to know for certain that something has gone wrong, and you don’t have to search for evidence – you just need to reasonably believe there is a cause for concern.

You should also bear in mind that you may have professional obligations to raise your concerns – for example, doctors have a professional duty to report concerns which might impact on patient safety.

Types of concerns that you might look to raise include:

  • Poor clinical practice
  • Unsafe staffing levels
  • Policy decisions which could negatively impact patient safety
  • Inadequate training
  • Inadequate responses to reported issues
  • Cultures of bullying or harassment
  • Fraud

What help can I get?

You can get support in raising your concerns from any of the following places:

  • In NHS England, you can contact your local Freedom to Speak Up Guardian to ask for advice and support in raising your concerns
  • In NHS Scotland, you can contact the Independent National Whistleblowing Officer’s advice line by telephoning 0800 0086 112 or emailing INWO@spso.gov.scot
  • Your trade union or professional body may be able to provide you with support

If you are a whistleblower who is struggling to find another job in the NHS after raising public interest concerns, you might be eligible for the NHS whistleblowers’ support scheme.

Will I be protected?

The NHS’s message is that staff should feel comfortable raising concerns or “speaking up”, and should not face negative treatment when they do so.

But things can go wrong, and so there are legal protections for workers who blow the whistle on wrongdoing at work. These are set out in the Public Interest Disclosure Act 1998 (or Public Interest Disclosure (Northern Ireland) Order 1998 if you are in Northern Ireland). This gives workers the right to bring an Employment Tribunal claim against their employer if they are treated badly because they have raised concerns.

This applies where you disclose information that you reasonably believe tends to show certain types of wrongdoing, which you reasonably believe is in the public interest.

You can raise your concerns internally, to someone senior to you within your organisation. You can also raise your concerns externally – there are different legal tests to consider depending on where you report your concerns.

If you meet these criteria, you have a right not to be victimised or dismissed because you’ve raised concerns.

Am I a worker?

Whistleblowing protections apply to a wider range of people than some other employment protections. If you are an employee, you will be in the group of people eligible for protection under PIDA. In the Health sector, there are also additional categories of individuals who wouldn’t ordinarily be protected by employment law, but do have protection under PIDA.

These exceptions can be complex, and you should contact us for further advice if you believe they apply to you.

We have included an overview of these exceptions:

Those who contract with the NHS to provide primary care services – medical, dental, ophthalmic and pharmaceutical – are included under PIDA. The NHS contracts listed include general medical, dental and ophthalmic services contracts, as well as local pharmaceutical services contracts. These are the standard contracts for professionals such as GPs and dentists working as sole practitioners or partners.

The employer is treated as being the relevant Primary Care Trust or Health Board. In many cases, the risk of victimisation will be more likely to come from colleagues working in the same practice than from the Trust or Health Board itself. In this instance, you would need to bring a detriment claim against those individuals as workers for the Trust or Health Board.

Student doctors can be protected when doing work experience provided as part of a training course or programme, or when they are provided with training for employment.

Nurses and midwives in training can be protected if they are doing work experience provided as part of education or training approved by the Nursing and Midwifery Council.

In both cases, this protection extends to acts done by the body providing the work experience (e.g. an NHS Trust).

As well as being protected as ordinary employees against the NHS Trust they work for, junior doctors can also be protected against their education and training body.  In Day v Lewisham and Greenwich NHS Trust, the Court of Appeal found that Health Education England could potentially qualify as a junior doctor’s employer for the purposes of PIDA, provided HEE substantially determined their terms of engagement.

Junior doctors in England and Scotland are also protected against Health Education England and NHS Education for Scotland respectively through agreements made with the British Medical Association.  These agreements provide the same protection as PIDA, but are enforced slightly differently. The BMA are trying to agree similar protections for junior doctors in Wales.

Within the NHS, there are protections for job applicants who make or have made protected disclosures. This applies to those applying for jobs with all NHS employers, including NHS trusts, clinical commissioning groups and health boards. This comes from the Employment Rights Act 1996 (NHS Recruitment – Protected Disclosure) Regulations 2018.

Agency workers are also eligible for protection under PIDA. This can apply against the health organisation where they are undertaking agency work, even if they don’t have a direct contract with that organisation.

What if I volunteer for the NHS?

Volunteers are not currently included in legal protections under PIDA. However, if you volunteer with the NHS in Scotland, you should be given access to the National Whistleblowing Standards, and be supported if you want to raise concerns.

Other NHS whistleblowing policies also mention volunteers. If you are a volunteer in England looking to raise concerns, you could contact your Freedom to Speak Up Guardian to discuss your options. You can also contact our Advice Line to discuss your situation.

Where should I raise my concerns?

Raise Your Concerns Internally

Usually this is the most effective way of having your concerns addressed. Your employer will be best placed to make changes to resolve any problems in the workplace, and is more likely to be able to act quickly.

It is a good idea to check your employer’s internal whistleblowing policy first. However, you can still be protected under PIDA if you raise your concerns to someone in a position of authority within your organisation, even if they’re not mentioned in the policy.

In each of the four jurisdictions of the UK, there are minimum standards for whistleblowing policies which apply across all health organisations. Generally, these policies recommend speaking with your line manager, lead clinician or tutor first. They should also give the details of other people you can speak to, if you don’t feel comfortable approaching your manager or if you’ve already raised your concerns to them. There are some different points of contact depending on where in the UK you are:

  • Freedom to Speak Up Guardian
    This is a network of independent, impartial professionals, whose role is to support staff in raising concerns and address barriers staff are facing. You should be able to find the contact details of the relevant Freedom to Speak Up Guardian in your organisation’s whistleblowing policy, or find them here.
  • Risk Management Team
  • Assigned Director
    There should be an executive and/or non-executive director on the Trust Board with responsibility for whistleblowing within the organisation who you can speak to.

You can find the standard policy for NHS bodies in England here.

  • Senior Manager
  • Whistleblowing Contact
    Organisations should provide a confidential contact who you can speak to about any concerns. They should usually be the first point of contact for concerns about fraud.
  • Speak-Up Ambassadors
    Some organisations will have speak-up ambassadors or advocates who can support you in raising concerns

All NHS service providers in Scotland are expected to follow the National Whistleblowing Standards, which set out processes for raising and dealing with whistleblowing concerns.

The Standards require employers to thank, listen to and reassure whistleblowers that their concerns will be handled sensitively, and to maintain the confidentiality of the whistleblower as far as possible. Managers are required to take action where they suspect a whistleblower is being or is at risk of being victimised.

They also set out time frames for responding to concerns. Where the concern is straightforward, the employer should provide a full response within 5 working days. Where it is more complex, the employer should acknowledge the concern in writing within 3 working days, and provide a full response within 20 working days or explain if the process is going to take longer to resolve.

  • Senior Manager
  • Chief Executive or another Executive Director
  • Local Counter Fraud Specialist
    They should be contacted about fraud or corruption.
  • Safeguarding Lead
    Where you have concerns about the safety of a vulnerable person, you should also consult any safeguarding policies in your organisation.
  • Designated whistleblowing adviser or advocate
  • HR or Governance team
  • Director with responsibility for whistleblowing

You can find the Health and Social Care model whistleblowing policy here.

Raise Your Concerns Externally

If you do not want to raise your concerns within your own organisation, or if your organisation doesn’t take action, you can approach the relevant regulator with your concerns instead. The relevant regulator will depend on what type of concern you want to raise. The following are some of the main regulators dealing with different issues.

For concerns about organisational issues...

Care Quality Commission

Contact them with concerns about treatment, care and support provided by services they regulate, including:

  • Hospitals
  • GPs
  • Dentists
  • Clinics
  • Ambulances
  • Mental health services

You can use their online form, or contact them by telephone on 0300 0616 161 or by email at enquiries@cqc.org.uk.

National Guardian's Office

Contact them with concerns about freedom to speak up arrangements within NHS bodies, or cases where concerns haven’t been handled properly.

Please note that the National Guardian’s Office cannot investigate the initial concerns themselves.

You can contact them by telephone on 01912 494 400 or by email at enquiries@nationalguardianoffice.org.uk. You can find more information here.

NHS Improvement

Contact them with concerns about:

  • How NHS trusts are being run (including unsafe patient care or working conditions, bullying cultures or conduct of board members)
  • Other providers with an NHS provider licence
  • NHS procurement, choice and competition
  • The national tariff

You can email them as a whistleblower at enquiries@improvement.nhs.uk.

Please note that NHS Improvement usually don’t investigate individual concerns, but use reports to look at wider issues within an organisation. You can find more information here.

NHS Counter Fraud Authority

Contact them with concerns about:

  • Fraud
  • Bribery
  • Corruption

You can contact them using their online form, or by telephone on 0800 0284 060. You can find more information here.

NHS England

Contact them with concerns about:

  • GP surgeries
  • Opticians
  • Dental practices
  • Community pharmacies

Including concerns about unsafe patient care, poor clinical practice, unsafe working practices, or improperly administered medicines.

You can contact them by telephone on 0800 0724 725, by email at england.contactus@nhs.net or by post. You can find more information here.

Health Education England

Contact them with concerns about:

  • Education and training for health care workers
  • Ensuring sufficiently skilled and trained health care workers are available to provide services

You can find more information here.

Independent National Whistleblowing Officer

Contact them if you feel your concerns are not being listened to or with concerns about whistleblowing processes within NHS Scotland.

You should exhaust internal routes first, but the INWO can accept concerns if there are strong reasons why you feel you can’t raise them internally.

You can complete their online form and find more information here. They also have a confidential advice line where you can get further advice and support.

Please note that the INWO is not currently a prescribed person, so this could count as a wider disclosure. You can get in touch with us for more advice on reporting your concerns to them.

Audit Scotland

Contact them with concerns about the use of public money within the NHS in Scotland.

You can complete an online form and find more information here.

Healthcare Improvement Scotland

Contact them with concerns about healthcare provision in Scotland.

You can complete their information template and email them – you can find more information here.

NHS Scotland Counter Fraud Authority

Contact them with concerns about possible fraud in the NHS in Scotland.

You can contact them by telephone on 0800 0151 628, or use their online form.

Please note that NHS Scotland Counter Fraud Services are not currently a prescribed person, so this could count as a wider disclosure. You can get in touch with us for more advice if you are looking to report concerns to them.

Healthcare Inspectorate Wales

Contact them with concerns about healthcare provision in Wales.

You can contact them by telephone on 0300 0628 163, or by email at hiw@gov.wales. You can find more information here.

NHS Counter Fraud Authority

Contact them with concerns about:

  • Fraud
  • Bribery
  • Corruption

You can contact them using their online form, or telephone on 0800 0284 060. You can find more information here.

Audit Wales

Contact them with concerns about the use of public money in the NHS in Wales.

You can contact them by telephone on 0292 0320 522 or by email at whistleblowing@audit.wales.

Regulation and Quality Improvement Authority

Contact them with concerns about the quality, safety and availability of health and social care services in Northern Ireland.

You can contact them by telephone on 028 9536 1990 or by email at info@rqia.org.uk. You can find more information here.

Health and Safety Executive Northern Ireland

Contact them with concerns about health and safety of staff in hospitals and nursing homes in Northern Ireland.

You can contact them by telephone on 0800 0320 121 or by email at mail@hseni.gov.uk.

Comptroller and Auditor General for Northern Ireland

Contact them with concerns about the proper conduct of public business or fraud and corruption within health service bodies in Northern Ireland.

You can contact them by telephone on 028 9025 1062 or by email at raisingconcerns@niauditoffice.gov.uk. You can find more information here.

For concerns about individual practitioners...

You can raise concerns about individual practitioners with the relevant professional body.

  • General Dental Council
  • Nursing and Midwifery Council
  • General Optical Council
  • General Medical Council
  • General Chiropractic Council
  • General Pharmaceutical Council
  • Pharmaceutical Society Northern Ireland
  • General Osteopathic Council
  • Health and Care Professions Council